DOI: 10.1002/alz.078778 ISSN: 1552-5260

Are elderly patients with atrial fibrillation sufficiently anticoagulated?

Espen Knut Trydal, Soffien Chadli Ajmi, Benedikte Lea Nygaard, Oystein Kallevag, Kathinka Dehli Kurz, Martin Wilhelm Kurz
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology
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Abstract

Background

Epidemiological and clinicopathological data show a significant overlap between cerebrovascular disease (CVD) and Alzheimer’s disease (AD)[1]. Atrial fibrillation (AF) is a significant risk factor for both stroke[2], and cognitive decline, and is also associated with all kinds of dementia including AD[3,4] (though a shared patho‐mecanism might be a factor in the link with AD[5]). As the elderly have a higher prevalence of cerebrovascular disease and AF, we wanted to explore the effect of age on anticoagulation status.

Method

From 2009 to 2022, we prospectively registered all acute stroke patients treated with endovascular thrombectomy (EVT). We recorded stroke‐risk factors, including atrial fibrillation and the status of anticoagulation. To examine a possible age inequality, we analyzed the effect of age over and under 80 years on anticoagulation status.

Result

438 patients were treated with EVT. The median age was 74 (IQR 63‐81). The median NIHSS before EVT was 17 (IQR 11‐21). 71 patients (16%) had a history of myocardial infarction and 59 patients of previous cerebral stroke (14%). 246 patients (56%) had hypertension, 61 (14%) diabetes, and 171 (39%) were diagnosed with AF. In 80 patients (18%), AF was newly diagnosed, and 97 (22%) had known AF. 60 patients (13.7%) were inadequately anticoagulated at admission. When dichotomizing around the age of 80, significant more elderly patients with AF were insufficiently anticoagulated compared to younger patients (43% vs 26%, p<0.018). Age as a variable was significantly associated with insufficient anticoagulation (p<0.001).

Conclusion

In this prospectively followed group of patients treated with EVT, a significant number of elderly patients with AF were insufficiently treated with anticoagulantia. Age was identified as a highly significant risk factor for inadequate anticoagulation. We suggest further studies addressing the association of AF with cognitive decline, dementia and AD, and especially the role of insufficient anticoagulation. We advocate improvements in the prophylactic treatment of AF in the elderly.

1. Whitmer, et al. Neurology. 2005Jan;277‐81.

2. Wolf, et al. Stroke. 1991Aug;983‐8.

3. Diener, et al. Journal of the American college of cardiology. 2019Feb;612‐9.

4. Bunch, et al. Heart rhythm. 2010Apr;433‐7.

5. Myers, et al. Frontiers in aging neuroscience 2022Jul

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